Methotrexate is indicated for the treatment of active rheumatoid arthritis and severe psoriasis. It is also used in the treatment of some other inflammatory arthropathies and skin conditions. In patients with inflammatory arthropathies, it is normally used together with non-steroidal anti-inflammatory drugs particularly in the early stage of treatment. 

This locally commissioned service (LCS) has been developed to promote the safe and effective prescribing of oral methotrexate in primary care.

Practices, if wishing to participate, can sign up for: 

• Level One: Secondary care will schedule and monitor blood tests to monitor oral methotrexate.
• Level Two: Primary care will routinely schedule and monitor blood tests for oral methotrexate under a shared care arrangement, referring back to secondary care as indicated in roles and responsibilities of the shared care guidelines.

Practices may provide a level one service for some patients until shared care is established or alternatively if they do not wish to participate in shared care.

Level two payments will be made for patients where shared care has been established and the monitoring of the patient on methotrexate is undertaken routinely by primary care.

GPs are encouraged to request the shared care of patients stabilised on oral methotrexate to increase convenience for the patient, reduce the need for outpatient attendances and to maintain or improve the quality of care.